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[oleva]

Have had a lot of trouble with uncontrolled bleeding and heavy periods which I have posted about before.  I was taking ultrogestan 100 day 10-12 of month twice a day and was on 75mg oestrogen patch.

I cut the  patch down to about 25 mg and stopped taking the ultrogestan.  I haven't had any bleeding at all for 6 weeks which for me is unbelievable.  I also feel so much better.  Have just come back from the doctors and am so disappointed because she said she thinks that I must take the ultrogestan otherwise I have a higher risk of womb cancer.  She said otherwise I must stop the patch which i don't want to do.  She says she will look into it and phone me next week.

Does anyone out there just take a low dose of oestrogen and no ultrogestan?  Or must I stop HRT altogether.  I don't want to as my symptoms where terrible.  Would love any advice.

[Cassie]

I am sure you dont want to hear this but it really is not safe to take just oestrogen unopposed like you are doing unless you want to chance it and have access to regular ultrasounds so that you can see what your womb lining thickness is. I am sure someone will be along who has more knowledge on this, perhaps Hurdity can advise. I too have been tempted to skip the Utrogestan but it did lead to a thickened lining and breakthrough bleeding so I really would not advise it.
Perhaps you can just take 100mg for 10 days a mth and have a bleed and an annual scan, that may be less traumatic for your system, I found the 200mg just too much. I think the only low dose oestrogen which one can take unopposed is the vagifem and not sure what dosage that is, it is a local application to treat VA.

[Taz2]

I believe that it is thought too risky to take unopposed oestrogen. Although you are feeling much better personally I wouldn't take that risk. This is what Cancer Research have to say about it http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer/risk-factors#heading-Two

Taz x 

[dazned]

You do need to use some progesterone alongside your estrogen.

Have you thought of having a mirena coil fitted,that would help with heavy bleeds too,just an idea.

[andius]

I have taken a course of 200mg DAILY and a course of 100mg DAILY for several months at a time.  The 200mg dose became intolerable after about 5 days and my doctor kept insisting until finally I became ill a few months later.  I have no problem at all with the 100mg daily....in fact it helps me sleep.  I tried the 25mg patch alone for a few weeks and liked it a lot but my doctor says I must take progesterone for the reasons noted above. I have tried the 100mg progesterone daily with a 25 mg patch and did not get enough estrogen with the progesterone on board....I do much better with the 50mg patch and daily 100mg progesterone.

It is a trial and error process to find what you need.  Just because you can't tolerate the cyclic 200mg utro that is suggested by many on this site does not mean that progesterone won't work for you.

There is a low dose 14mg patch that is used for osteoporosis (Menostar)....possibly wouldn't need utro with this.?

[Hurdity]

The Menostar patch - which is not available in UK - does require progesterone - according to the info I read about it some time ago ( I think I posted about it on here a couple of years ago?), but just not as often as with higher doses of oestrogen. However the dose is so low as to be almost negligible I would say!

The only oestrogen that does not require a progestogen is vaginal oestrogen eg Vagifem or estriol cream - as that gives only minimal systemic absorption especially after the first 2 weeks loading.

I agree - it is not advisable. The only situation some gynaes prescribe extra oestrogen (without added progesterone) is in women who are still having regular periods but require a boost in oestrogen to help with mood or with reproductive depression. In this case the woman's own progesterone is sufficient to shed the lining. This would only be recommended in any case under gynae supervision.

Hurdity x

[andius]

For those interested in Menostar: from the (Bayer) manufacturer info ( I put the asterisks to delineate their recommendations re: progestin )

2 DOSAGE AND ADMINISTRATION
Generally, when estrogen is prescribed for a postmenopausal woman with a uterus, a progestin should also be considered to reduce the risk of endometrial cancer.**** It is recommended that women who have a uterus and are treated with Menostar receive a progestin for 14 days every 6 to 12 months and undergo an endometrial biopsy at yearly intervals or as clinically indicated in order to detect any endometrial stimulation which might require further clinical action. A women without a uterus does not need a progestin. ****In some cases, however, hysterectomized women with a history of endometriosis may need a progestin [see Warnings and Precautions (5.2, 5.14)].
Use of estrogen-alone, or in combination with a progestin, should be with the lowest effective dose and for the shortest duration consistent with treatment goals and risks for the individual woman. Postmenopausal women should be re- evaluated periodically as clinically appropriate to determine if treatment is still necessary.

****************************************************
14 days once or twice a year is not too bad IMO, but it may not be enough estrogen to treat symptoms as it is formulated for osteoporosis

A

[Taz2]

I found an old thread about Menostar http://www.menopausematters.co.uk/forum/index.php'topic=14117.0

Taz x 

[matildamouse]

Oleva, I would also love to know the answer to this one. There probably is not one... I am struggling with progesterone as well and feel so much better on the patch only but know I have to take progesterone sometime again...

[Cassie]

That sounds a bit drastic, undergoing a biopsy annually, surely a scan would suffice.....